Door to needle (DTN) time for thrombolysis in the Emergency Department, Universiti Kebangsaan Malaysia Medical Centre (ED, UKMMC) is an indicator that can reduce mortality and morbidity of patients with ST Elevation Myocardial Infarction (STEMI). This study was conducted to determine factors that influence DTN time for acute ST Elevation Myocardial Infarction (STEMI) and whether it has achieved the recommended time of 30 minutes. A cross-sectional study was conducted among patients diagnosed with acute STEMI and thrombolysed in ED, UKMMC from June 2016 until March 2017. A data collection sheet was used to collect patient’s demographic data and clinical data which included time of arrival to ED, time of initial electrocardiogram (ECG), time of drug preparation and time of thrombolytic delivery to the patient. A total of 98 patients were included in this study. Majority of patients (77.6%) were thrombolysed more than 30 minutes following ED arrival. Mean DTN in ED, UKKMC was 59.28 + 36.01 minutes. The mean door to ECG time was 7.19 + 8.08 minutes and the mean drug preparation time was 9.86 + 7.51 minutes. Out of 76 (77.6%) patients that were thrombolysed after 30 minutes of ED arrival, 59.2% (n=45) were due to multiple disciplinary referral. Other factors were delay in performing initial ECG 19.8% (n=15), incorrect initial ECG interpretation 9.2% (n=7) and unavoidable need for prior resuscitation 9.2% (n=7). As a conclusion this study showed that there was an unacceptable delay in hospital thrombolysis for acute STEMI.
Thrombolysis in Acute ST Elevation Myocardial Infarction: Determination of Door to Needle Time in a Tertiary Medical Centre
Author
Abstrak
Waktu pintu kepada jarum untuk trombolisisis di Jabatan Kecemasan, Pusat Perubatan Universiti Kebangsaan Malaysia (ED, UKMMC) adalah penunjuk yang boleh mengurangkan kematian dan morbiditi pesakit infark miokardium beserta peningkatan ST (STEMI). Kajian ini dijalankan untuk mengenalpasti faktor-faktor yang mempengaruhi masa dari pintu ke jarum untuk STEMI dan adakah ia telah mencapai masa yang disyorkan iaitu 30 minit. Satu kajian keratan rentas dijalankan di kalangan pesakit yang telah dikenalpasti mengidap STEMI akut dan trombolisis dijalankan di ED, UKMMC dari Jun 2016 hingga ke Mac 2017. Borang pengumpulan data digunakan untuk mengumpul data demografik dan data klinikal pesakit termasuk waktu elektrokardiogram (ECG) pertama, masa penyediaan ubat trombolitik dan masa pembemberian ubat trombolitik kepada pesakit. Sejumlah 98 pesakit terlibat di dalam kajian ini. Majoriti pesakit (77.6%) telah menerima ubat trombolitik dalam masa lebih daripada 30 minit selepas ketibaan di ED. Purata masa pintu ke jarum dalam ED UKMMC adalah 59.28 + 36.01 minit. Purata masa melakukan ECG ialah 7.19 + 8.08 minit dan purata masa penyediaan ubat ialah 9.86 + 7.51 minit. Daripada 76 (77.6%) pesakit yang menjalani trombolisis selepas 30 minit ketibaan ED, 59.2% (n=45) adalah disebabkan oleh rujukan pelbagai disiplin. Faktor lain ialah kelewatan dalam melaksanakan ECG pertama 19.8% (n = 15), interpretasi ECG pertama yang tidak tepat 9.2% (n=7) dan resusitasi pesakit sebelum trombolisis boleh dilakukan iaitu 9.2% (n=7). Sebagai kesimpulan, kajian ini menunjukkan bahawa terdapat kelewatan trombolisis di hospital yang tidak boleh diterima dalam kes STEMI akut.
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